Fair & balanced on circumsion

By Razib Khan | April 4, 2011 11:48 am

When Michelle mentioned on Twitter that she was going to write about circumcision, I told her to expect some angry people to come out of the wood-work. Today she has a post up at Scientific American, What’s the deal with male circumcision and female cervical cancer? She concludes:

In addition, while it is true that women with circumcised partners are less likely to get cervical cancer, they are not immune. Women with circumcised partners still contract HPV and develop cervical cancer! They just do it at a reduced rate.

There are other methods that are much more likely to reduce a woman’s chance of contracting HPV and developing cervical cancer, such as vaccination and condom use. Therefore, from a public health standpoint in the United States, it may not be necessary to circumcise male babies solely for the purpose of reducing the risk of cervical cancer in his future sexual partners (of course, this doesn’t take into account the possibility that the child might not be heterosexual).

On the whole I think that Michelle’s take is reasonable and fair-minded. But, I think numbers are of the essence here. What is the expected reduction in rate of risk? This was the major bone I had to pick with Jesse Bering’s post on this topic last year at Scientific American. Bering closes on a pro-circumcision note on public health grounds:

I started this piece with an open mind but I’ll close by putting my cards clearly on the table. For me, if one fully appreciates the scientific findings reported by these landmark studies with sub-Saharan African men, circumcision is the more humane decision. Some minor bloodletting today could spare that child unthinkable degrees of suffering tomorrow. Nobody knows where your child will live as an adult (perhaps Africa), or how rampant HIV will be there, or whether he’ll wear a condom every time he has sex with a stranger, or whether an infected, beautiful woman will cross his path on the day he forgets to tuck a condom into his wallet. Admittedly, my own “son” is a border terrier, but this issue is still a no-brainer to me. However, I’m well aware that male circumcision is a contentious topic for many people, some of whom, aghast, will make their opinions known to me in the coming days.

If I’m not being generous, I’d have to say that circumcising your son because he might live in Africa which might still have a rampant HIV epidemic 20-30 years from now, is kind of a stupid decision if grounded on probabilistic logic. After all the probabilities of the various outcomes contingent upon your priors matter. My future children will be raised in the United States of America. If male, they will likely be straight. They will probably middle to upper-middle-class. HIV rates vary a great deal by demographic category. I know I won’t allow my sons to be circumcised as infants. I don’t see the need, and I am familiar with the literature on the efficacy of mass circumcision in preventing the spread of sexually transmitted diseases in some environments.

But, if I lived in South Africa I might make a different decision based on the probabilities of my different environment. This is why I would dissent a bit from Michelle’s note that even women with circumcised partners can develop cervical cancer. Risk assessment, by its nature, should not be viewed dichotomously. To make proper decisions based on probabilities you need to take into account the magnitudes of all the risks.

CATEGORIZED UNDER: Health, Medicine
MORE ABOUT: Circumcision
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  • http://ecophysio.fieldofscience.com/ EcoPhysioMichelle

    Yeah, that’s why I added the caveats in that I was only talking about the USA. Even a small reduction in risk is something to consider on the population level when we’re talking about places where the risk factors are high and prophylactics aren’t easy to obtain.

    I can handle the angry commenters. I know people get VERY vehement about a little flap of skin. :)

  • http://blogs.discovermagazine.com/gnxp Razib Khan

    david, it’s not an order of magnitude for my children. HIV does not effect all demographics equitably in the USA. that’s obviously at the link i provided closer to two orders.

  • I_Affe

    Who needs circumcision to prevent HIV when one can just apply topical oestrogen? Free paper here

  • omar

    Circumcision is one of those things that if we did not have a religious sanction for it, would never show up on our radar at all. Once we start snipping off some of that skin, we can dig around and find some rather remote risks and tote up the whole population numbers and claim its better to do it. But I dont really buy it. Even if the risk of transmission is slightly lower, there are other things an individual can do to reduce such a risk. WHile they may not alter the calculus too much, rare but devastating complications of circumcision should be counted…they are very rare in the US, but more common in Africa; how many lost penises are worth how many fewer cancers and so on? and what about asking the boy if he wants it done? Can we do it when they are grown up? (I know healing is faster in infants, but its not exactly brain surgery, it can be done in adults too).
    Finally, are there other things we can do that change population wide risk by some minute amount and do we do all of them with the same dedication as we snip foreskins? somehow, I dont think so.

  • Ian

    The whole issue of pushing circumcision as a way to avoid HIV (or HPV transmission) misses the point entirely. What matters isn’t statistical significance, it’s effect size. More importantly, things like this don’t exist in isolation.

    To begin with, presumably what Bering characterises as “some minor bloodletting” is also a lifetime alteration is sexual experience (which, of course, Wikipedia hasa whole article about). But sure, that’s beside the point when you’re talking about life and death, right? Except, of course, that it’s not.

    Bering’s argues that “in medical settings, these complications are extraordinarily rare”. By which he’s talking about medical settings in developed countries, where needles don’t get reused. But in those countries access to condoms and access to anti-retrovirals are also likely to be good. More to the point, his hypothetical about future rates of HIV infection, where his son might live, and the possibility of an encounter with “an infected, beautiful woman” on the day he “forgets to tuck a condom into his wallet” are low-probability events.

    Teaching your kids to use condoms and teaching them to be comfortable with the idea of using condoms is a far more effective strategy. It’s funny really, considering that Bering is a psychologist that he doesn’t consider how the belief that they’re “safe” (because they’re circumcised) would factor into the likelihood that a person would use a condom. After all, it’s only a 62% reduction in risk. That means that half the people who would otherwise become infected with HIV still do. Since they now believe that they are immune to HIV (because nuance is lost on most people), they’re more likely to keep having unprotected sex. And (a) infect your daughter (or gay son) with HIV, and (b) get her pregnant.

  • AG

    Male Foreskin=Female labia minora in term of embryology and sexual sensation. The men who lost their foreskin as infant would never know what they missed. Ask your femal partner about how it would be like without that `male labia minora’

    Guys who got their circumcision as adults all admit a great loss of pleasure.

  • Ian

    David, yes the case for circumcision is much higher in South Africa. But so is the risk of complications (or Hep B or C infection) when you’re being circumcised. The difference is between a 0.1 and a 0.2% risk over 2 years. Surely education could have a much bigger effect than circumcision (and the side-effects of education aren’t as severe).

    Bering talks about p values, but ignores effect size. When you’re talking about public health issues, effect size matters at least as much as p values.

  • Karoly

    omar Says:
    “I know healing is faster in infants, but its not exactly brain surgery, it can be done in adults too.”

    Right. Not exactly, but almost. I have repeatedly observed that in certain situations that’s exactly where my brain migrates to.

  • bart

    I’m gonna cut it short. I was circumcised at the age of 7, and i think that in any secular country, it should be banned for anybody, under the age of consent unless it is for medical emergency purposes.

    http://abcnews.go.com/Health/video/circumcision-banned-12227635

  • onur

    Circumcision is nothing but body mutilation and, like every form of body mutilation (including tattooing, piercing, cranial and every other artificial body deformation, body painting), I find it barbaric and abhor it.

  • Equal

    Show me a situation where an infant will be engaging in high risk sexual activity – then i will consider STD protection options for him.
    Partial amputation of the penis for partial STD protection relies on the ASSUMPTION that the current infant will engage in high risk sexual activity.

  • dan

    meh, i just don’t like the way uncircumcised looks. if i had kids i’d cut ‘em! it’s kinda become the new SWPL thing to be “outraged” about. i suspect it has to do with hating Israel….

  • http://blogs.discovermagazine.com/gnxp Razib Khan

    i suspect it has to do with hating Israel…

    are you joking, or just being retarded?

  • dan

    you don’t hang out at reddit much do ya? you’d probably know what i mean if you did. unrelated note: updated race maps from the new census
    http://www.flickr.com/photos/walkingsf/sets/72157626354149574/detail/

  • http://blogs.discovermagazine.com/gnxp Razib Khan

    you don’t hang out at reddit much do ya? you’d probably know what i mean if you did. unrelated note: updated race maps from the new census

    i know that some anti-circ activists get into anti-zionist stuff. and i know some jews perceive anti-semitic intentions. it’s a retarded sideshow. most of the circumcised men in the world are muslim (70%), and most of the rest are christian americans and africans. fixating on jews is something retards do (gentile and jewish). if you’re going to do it, i’ll call you a retard too, if you let retard perceptions become your own.

  • dan

    what? i simply said i *suspect* that the (movement against circumscision) is, at least, partially rooted in a strong dislike for Israel. i’m not going to admit how much time i spend on reddit but you can do a search yourself. see how many entries there are related to male circumscision in comparison to female circumscision or, for that matter, anything else that’s more important and you’ll see what i mean. it’s so prevalent i had to ban the word “circumscision.” combine that with the fact the reddit is basically an Israel bashing site filled with hipsters and you can see why i am at a loss to explain the number of threads about it there. everyone knows they refuse to say much that’s negative about muslims of africans. reddit is a pretty good place to catch the SWPL vibe so don’t assume i’m basing it on nothing. do you see what i mean, though? the amount of attention it receives is, imo, way out of purportion with it’s relevance. that makes me suspicious just like constant posts about HFCS, GMOs and the “evils” of nuclear energy. that’s simply my take after spending years there so do with that what you will. *it’s exactly the same reason why Kosher food and factory farmed meat are cirticized but hardly ever halal. and why they think killing and eating cats in Korea is equal to farming chickens: it’s the “cool” thing to believe.* i’m not gonna get angry at you cuz you give me such great free info otherwise

  • http://blogs.discovermagazine.com/gnxp Razib Khan

    dan, yes, there is a certain fadish element in the anti-circ movement. but sorry, using reddit as a representative sample is not just going to cut it with me. the history of circumcision and anti-circumcision since the 19th century in the west has some relationship to anti-semitism, but it is a marginal issue. if you are saying that SWPL hatred of circumcision has something with anti-israel sentiment. perhaps. i don’t know, and am not too interested in viewing the issue through an SWPL lens.

  • dan

    fair enough as i said that i *supect* which implies that i know i could be wrong but there are several hundred thousand libs that go there every day. i personally think it alings very much with comments on the NYT and HuffPo. anwyay, a question: since you don’t approve of “cutting” then would you approve of my parents turning off my baldness gene after i was born because they “don’t like the way it looks”? or would this be unnatural and “genomic mutilation”? one can imagine other analagous scenarios for the future. just wondering…(also, it is possible to correct an unwanted cut by stretching the forskin with a stretch kit.)

  • http://blogs.discovermagazine.com/gnxp Razib Khan

    since you don’t approve of “cutting” then would you approve of my parents turning off my baldness gene after i was born because they “don’t like the way it looks”? or would this be unnatural and “genomic mutilation”? one can imagine other analagous scenarios for the future

    if elective cosmetic gene therapy gets common i think there should be some norm to allow the kid to make a choice later because there are probably going to be functional trade offs (and frankly, risks) if you do something like this. and why are you using scare quotes? you aren’t quoting me. i didn’t use the word mutilation. you know i don’t generally appreciate it when people impute terms to me which i didn’t use.

  • dan

    because they’re very common phrases used from both sides of the argument. i just used the latter earlier. i was jokingly imagining “genomic mutilation” being the new catch phrase and it’s also 3 in the morning. and come on, now, R – i didn’t use your name after the quote so there’s no reason to assume i *was* quoting you. not everyone’s out to get you;) thanks for the discussion.

  • Micheal Corrison

    I’ve read a few of the U.N statements:

    “Reproductive rights rest on the recognition of the basic right of all
    couples and individuals to decide freely and responsibly the number,
    spacing and timing of their children and to have the information and
    means to do so, and the right to attain the highest standard of sexual
    and reproductive health. They also include the right of all to make
    decisions concerning reproduction free of discrimination, coercion and
    violence.”

    “The human rights of women include their right to have control over
    and decide freely and responsibly on matters related to their
    sexuality, including sexual and reproductive health, free of coercion,
    discrimination and violence. Equal relationships between women and men
    in matters of sexual relations and reproduction, including full
    respect for the integrity of the person, require mutual respect,
    consent and shared responsibility for sexual behavior and its
    consequences.”

    So why doesn’t this apply to the male’s right to keep his foreskin at birth?
    I’m so sick of hearing women tell me that slicing off the foreskin at
    birth wasn’t mutilation and a human rights abuse…I WOULD HAVE WANTED
    MY FORESKIN! It was my body, it should have been my choice. I thought
    children were protected in your vision? Yet you ENCOURAGE circumcision
    of infants for the sake of adult women’s health- it’s sickening. So
    boys don’t deserve bodily integrity? Over 1,000 boys die every year
    from the practice, yet it’s not mutilation because their male.
    Why is it that disparities and discrimination against men are
    completely ignored? Any time a situation is sexist against men, it
    receives absolutely no attention whatsoever.

  • Joseph4GI

    I’m against FGM. Perhaps there’s a part of me that hates Africa? Indonesia? Malaysia? Singapore?

    Uh, yeah. Look um, circumcision is not exclusively Jewish, OK? 93% of circumcised men in the US are secular, non-Jewish men who got circumcised at a hospital. OK?

    Stop trying to make this about “hate for Israel” and “hate for the Jews,” because it’s not.

    I am against the genital mutilation of infants, no matter what sex, no matter what race, and no matter what religion his parents are.

  • onur

    I’ve read a few of the U.N statements:

    .
    .
    .

    So why doesn’t this apply to the male’s right to keep his foreskin at birth?
    I’m so sick of hearing women tell me that slicing off the foreskin at
    birth wasn’t mutilation and a human rights abuse…

    Ask that to Muslim and Jewish lobbies.

    BTW, I don’t give a fuck to what multiculturalist organizations like the UN say.

  • http://ecophysio.fieldofscience.com/ EcoPhysioMichelle

    Dan, I am unaware of to what extent, if at all, the anti-circumcision movement is based in antisemitism, but I don’t think the internet, especially reddit, is an accurate yardstick for measuring public opinion.

    As I’ve stated elsewhere, I’m not inherently anti-circumcision. If someone wants to do it to themselves, be my guest. I’m not going to do it to my kids, not because it’s ~what white people like~ (even though I am white), but because my experience with uncircumcised partners has led me to the opinion that uncut penises are better, aesthetically and functionally. If my kid grows up and says he’d rather be cut, fine, we’ll do it. The great thing about NOT circumcising your kid is that you can change your mind about it later. Not so much with the other way around.

  • Sandgroper

    “I don’t give a fuck to what multiculturalist organizations like the UN say.” Onur! Language! Yes, I agree with you 100%

    Look, mutilation of the sexual organs of infants and children too young to make their own choices, both male and female, is a very big deal. It should be criminal, end of story.

    I was circumcised at birth (Christian). I have a dear sweet childhood female Indonesian friend who got hacked (Muslim). Sometimes we sit together in a corner and sob about it. No we don’t, but we are good enough friends to be able to discuss it, and we do both sincerely wish that meddling fucked-up adults everywhere would keep their hands off the private parts of innocent children.

  • Bud Yanker

    Scientifically, you are dealing with two linked issues. The “health” arguments are created with every generation. While reasonable research and epidemiology shows that in industrialized countries, the procedure is non-therapeutic and is just cosmetic surgery. Eventually, the African program will be proven ineffective, with true scientific methods (antivirals, condoms, education, new research) saving the day.
    From a sociological perspective, the only people who push this “procedure” are those that have been subject to it. I’m sure if Michelle researched that aspect, she would expose the bias and the cycle of abuse that is the real problem. In both males and females, the perpetrators are they themselves victims of the procedure. Eventually, women will end the procedure because they will overwhelmingly understand that both female and male genital mutilation are psychologically identical, albeit some female forms are even more cruel.

  • dan

    michelle, you don’t think hundreds of thousands of comments on the internet from a specific group are an accurate yardstick to measure opinions? what am i to think of your comment then? i simply said i SUSPECT it has to do with israel hate. that can mean it has anywhere from everything to nothing to do with it.
    http://www.sfexaminer.com/local/2011/02/san-francisco-circumcision-ban-headed-november-ballot
    see, when SWPLs like yourself become hysterical about something like this is just makes me naturally suspicious. all this time spent on something that really doesn’t matter that much when the same crowd never bothers to spend time on much worse offenses like: fat people having kids and making them fat (child abuse,) religious people raising their kids to be religious (child abuse), actually *having* kids in the first place (environment abuse), halal and Kosher animal slaughter (animal abuse), poor people having kids, low IQ people having kids, people with genetic disorders having kids, people with high potential to have kids with genetic disorders, single parents intentionally having kids, etc. These are all things that are way way worse and get hardly any attention. Instead i constantly have to hear about GMOs, HFCS, global warming (it exists but there’s nothing we can do about it), flouride in the water, Palestine, alternative medicine, etc. So when something in your crowd becomes “cool” to be outraged about i natuallry become suspicious and start to have to make some correlations to explain the hysteria. got it? don’t blame me for trying to explain misplaced outrage…It’s hard for me to see how liberals always say “to each his own” about religion except for this *one* issue even though they’re, basically, religious themselves because thay believe in things like alternative midicine. i’m not saying circumscision is wrong to dislike….i was just sayin’

  • http://ecophysio.fieldofscience.com/ EcoPhysioMichelle

    1) I would thank you to not project your opinions of liberal white people on me nor to assume what my stance is on any of the issues you raised.

    2) No, I honestly do not think that thousands of comments by redditors is a good yardstick for measuring public opinion. Redditors are self-selected so they are naturally going to be a biased sample.

  • dan

    ok, then remove the words “like yourself” from my comment.

    if you don’t think that reddit’s opinion, which is virtually analagous to NYT and HUffpo, Kos, demunderground comments, represents liberals then you might want to rethink that. yes, liberals are a self selected group. we’re not measureing public opinion, we’re measureing the opinion of those who are in the anti-circumscision movement.

  • http://ecophysio.fieldofscience.com/ EcoPhysioMichelle

    The first thing we learn in 100-level statistics is that voluntary surveys on news websites are not representative of the population. It doesn’t take a leap of the imagination to apply the same logic to internet comments. I’m not going to engage in this type of speculation with you.

  • dan

    again, we’re not talking about the population we’re talking about SWPLs. if you actually did a survey of the population that would actually help *my* case as most people wouldn’t care, wouldn’t know anything about what you’re asking and half of them would be conservative. most would be religious. most would be circumscised.

  • http://TLCTugger.com Ron Low

    There was a report about a year ago about deaths associated with the Gardasil vaccine for HPV. I did the math. Even if ALL the suspected Gardasil deaths were ACTUALLY caused by it, infant circumcision is 27 TIMES DEADLIER per patient than the HPV vaccine.

  • slek

    I have to accept “Herpesmingle” is a good platform for people with HPV or other STDs

  • http://None Jack

    Many in this blog testify to their abhorrence of circumcision as a form of bodily muilation…….what aboutspiritual mutilations brought on by all manner of “Religions”??????????????????????

  • http://occludedsun.wordpress.com Caledonian

    There have been more prior claims for health benefits from circumcision than I can easily recount. And each one has not only been shown to be wrong, but that they were never really supported by the data in the first place – and each one is in turn abandoned and never mentioned again, once it becomes obvious to the scientific community that it’s bunkum.

    And then the new claims are trotted out with the announcement that “Now we know that….”

    If you look at the totality of research, the evidence clearly shows that circumcision increases incidence of STDs dramatically, with the sole exception of the one disease that benefits from contact with the immune system: HIV. And the decrease in risk isn’t enough to justify damaging the penis, especially since the most effective means of avoiding HIV infection also reduces the risk of the other STDs – condoms.

    By and large, most of the people with an opinion on circumcision reached their conclusions first and looked for arguments to support them after. Those who didn’t, have pretty much come to the same, obvious conclusion.

  • No Self Control

    And now for something completely different…
    Razib, you’re an incredibly smart scientist, so it’s really grating when you use the word “retard”.

  • http://blogs.discovermagazine.com/gnxp Razib Khan

    got a better word for moron?

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  • Scott Finnell

    I think circumcision is barbaric. I wish I had a choice in whether or not I was circumcised. Circumcision makes men’s penises less sensitive. The extra skin is full of nerves that make sex more pleasurable. I don’t believe in it, and it is really unnecessary. It is really about religion and old ideas. If I had boys, I would never let them do this to them. I was told it was mostly about hygiene as to why they did it to me in the first place. It should be banned as an outdated barbaric practice.

  • http://blogs.discovermagazine.com/gnxp Razib Khan

    these comments are in a rut. i’m closing the thread. #38, email me at contactgnxp -at- gmail -dot- com for a better term for stupid people or stupid arguments.

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This blog is about evolution, genetics, genomics and their interstices. Please beware that comments are aggressively moderated. Uncivil or churlish comments will likely get you banned immediately, so make any contribution count!

About Razib Khan

I have degrees in biology and biochemistry, a passion for genetics, history, and philosophy, and shrimp is my favorite food. In relation to nationality I'm a American Northwesterner, in politics I'm a reactionary, and as for religion I have none (I'm an atheist). If you want to know more, see the links at http://www.razib.com

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